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It’s risky business. Postponing health-related procedures to save money may be hazardous to your life.

Three months ago, the Hawaii Medical Service Association by revoking their earned “gold cards” that allowed them preapproval to order medical tests without delay.

These are the same physicians and specialists who in 2011 received that said:

“Your record of precertification requests validates that you consistently utilize and apply appropriate clinical criteria when ordering advanced imaging. Therefore you will be waived from precertification for MRI, MRA, CT, CTA … scans.”

The time-sensitive imaging tests include magnetic resonance imaging, nuclear cardiology stress tests, computerized tomography scans and stress echocardiograms. HMSA granted the red tape-waiving ability for the righteous sake of delivering the best possible patient care. That was then.

This is now. Since the “gold cards” were yanked from these doctors, who are among some 1,600 active physicians in HMSA’s network, the results show:

• delays in patient care
• specialists stopped from delivering their full scope of professional assessments and expertise without waiting until patients are in the hospital, urgent care or emergency room
• opening the door to lawsuits stemming from cost-containment efforts for which legal precedence was set in the patient’s favor in at least one Blue Cross case

One surgeon at a medical center on Oahu has more than 30 years’ professional experience and is highly sought after for her life-saving abilities. After her “gold card” was terminated, denials for her patients’ testing orders tripled from about five while she had her “gold card” to about 15 at any given time.

She has always complied with HMSA’s requests to submit records for ongoing evaluation of appropriateness of care and to meet the 90 percent approval rate on all reviewed records.

In addition, new patients now wait about three weeks for a first visit to her office because admittance hinges on tests. Previously, new patients waited one and a half weeks on average. Now some new patients are “flat-out denied” care, the doctor’s office said, because in Arizona – the company that HMSA contracts to judge the legitimacy of doctors’ ordered tests in Hawaii – deemed that the procedures were unnecessary.

NIA’s web page boasts: “… our clients come to us for customized solutions that optimize … affordability. …With National Imaging Associates (NIA), you benefit from … financial resources that allow us to achieve bottom-line results and guarantee multi-year cost savings. No other solution offers you . . . more control. More power to you.”

“More power” to HMSA means less power to the patients. Loss of high quality, timely patient care are part of the collateral damage. In this physician’s office, which is typical of what doctors are experiencing, the lessening of professional care is attributed to:

• increased time needed to educate staff about insurance plans and coding
• doubled time for administrative work
• devoting about three hours per workday to complete test orders that were previously preapproved
• follow-up time to process denials from NIA and for the doctors’ subsequent appeals
• redoing work, when NIA calls with questions or to request paperwork, which was provided in the original filings
• increased staff turnover

, which has cleared the House and is in the Senate, would prohibit health insurance preauthorization requirements that cause undue delay in receipt of medical treatment or services. It specifies that insurers, but not health care providers, are liable for civil damages caused by undue delays for preauthorization.

HMSA’s abolishment of its waiver policy affects patients, doctors, staff and potentially much-needed specialists from elsewhere. Physicians, especially if they had previously earned waivers for preapprovals and who might contemplate practicing medicine here, would not want their judgment about test orders routinely questioned.

The argument that revoking this policy protects patients from too much radiation is weak. Doctors collaborate with each other; they review patients’ records including tests; and they are aware. It’s what they do. Also, not every patient fits the textbook guidelines of NIA. We have specialists because they know more than routine, textbook health solutions.

Lastly, the costs incurred by HMSA when if it is sued by patients for claims of negligence and other actions will not outweigh the savings from cost-containment restrictions that NIA promises HMSA. The tort of insurance bad faith that comes from insurers breaching their duty of good faith and fair dealing was firmly established in Hawaii by the Hawaii Supreme Court’s landmark decision in

Furthermore, the California Court of Appeals found in 2013 that the administrator of a health care plan owes a duty to plan members to exercise due care to protect them from physical injury caused by its negligence in making benefit determinations under the plan.

So call it risky business, monkey business or bad business. People never win when doctors’ skilled hands are tied by a corporate insurer. Requiring these physicians and specialists, who had previously earned HMSA’s precertification approval, to go through each step in the approval process doesn’t save patient lives. It only helps HMSA’s bottom line.